- Resource Type:
- Presentation
215. Left Atrioventricular Valve Regurgitation is Not a Risk in Modified Single Patch Technique Unless Deep Ventricular Septal Defect
May 17, 2022
Carl Backer , Invited Discussant , Cincinnati Children's Hospital Medical center
Yasuyuki Kobayashi , Abstract Presenter , Boston Children's Hospital
102nd Annual Meeting, Boston, MA, USA
Hynes Convention Center, Room 210
Abstract
Objective: This study aimed to evaluate the impact of a modified single patch repair (mSP) for atrioventricular septal defect (AVSD) on competence of left atrioventricular valve (LAVV) in comparison to two patch technique (TP), and identify risk factors incorporating LAVV morphology for significant LAVV regurgitation or LAVV-related reoperation.
Methods: This retrospective study included 118 patients with AVSD who underwent intracardiac repair (ICR) between June 1998 and September 2020, including 69 patients (58%) who underwent mSP and 49 patients (42%) underwent two patch repair (TP). Demographics, perioperative data and outcomes were compared between the two groups. Risk factors for significant LAVV regurgitation or LAVV-related reoperation were analyzed using Cox regression analysis. The median follow-up period was 10.4 (4.9-14.4) years. Freedom from significant LAVV regurgitation or LAVV-related reoperation were estimated with Kaplan-Meier method. Propensity score matching was performed for comparison of freedom from significant LAVV regurgitation or LAVV-related reoperation.
Results: Weight at ICR did not differ between the two groups (mSP: 5.4 [4.3-6.2] vs. TP: 4.8[3.9-6.6] kg, P = 0.339). Preoperative ventricular septal defect (VSD) depth in the mSP group was significantly less than that in the TP group (7.3 ± 2.5 vs. 8.9 ± 2.4 mm, P = 0.001). Distribution of preoperative LAVV regurgitation grade was mostly equivalent between the two groups (P = 0.543). Mean aortic cross clamp time was shorter in the mSP group (81 ± 23 vs. 98 ± 27 minutes, P = 0.001). There was one hospital death and one late death. Freedom from significant LAVV regurgitation or LAVV-related reoperation was lower in the mSP group (mSP: 89%, 42%, 17% vs. TP: 86%, 65%, 53% at 1, 5, 10 years, P = 0.024). Weight < 4.0kg at ICR, VSD depth index (VSD depth divided by body surface area) >35, and preoperative significant LAVV regurgitation were identified as risk factors for significant LAVV regurgitation or LAVV-related reoperation both in the mSP group and all cohorts, despite only VSD depth index >35 was not included in the TP group. The propensity score matching extracted 21 matched pairs according to multiple baseline covariates including associating anomalies and anatomical features like VSD depth and grade of LAVV regurgitation. The VSD depth index in matched cohort did not differ between the two groups (26.8 ± 11.6 vs. 27.7 ± 7.9, P = 0.769). This analysis found no significant difference in freedom from significant LAVV regurgitation or LAVV-related between the two groups (mSP: 100%, 48%, 38% vs. TP: 95%, 76%, 57% at 1, 5, 10 years, P = 0.334).
Conclusions: Incidence of LAVV regurgitation after repair of AVSD was not negligible in both techniques. Unless VSD is not deep, mSP provides similar LAVV competence compared to TP. Appropriate surgical approach should be applied according to variation of anatomies specifically VSD depth.
Yasuyuki Kobayashi (1), Yasuhiro Kotani (2), Shingo Kasahara (2), (1) Okayama university hospital, Okayama, Okayama, (2) Okayama University Hospital, Okayama, Okayama
Carl Backer
Invited Discussant
Mayo Medical School, Northwestern CV Surgery and Congenital Heart Surgery.
Chief of Pediatric Cardiac Surgery at Childrens Memorial in Chicago from 2008 - 2018
Current Chief of Pediatric Cardiac Surgery Kentucky Children's Hospital.
Co - author of the text Pediatric Cardiac Sugery.
Past President CHSS, Current director ABTS.
Yasuyuki Kobayashi
Abstract Presenter
Dr. Kobayashi has been a clinical fellow at Boston Children's Hospital and a former cardiovascular surgery clinical fellow at Okayama University Hospital in Japan. He obtained a Ph.D. at Okayama University in 2021 with a study of ex vivo heart perfusion for DCD hearts with large animals.
Dr. Kobayashi’s clinical interest encompasses open heart surgery in neonates and infants with complex congenital heart diseases and valve disease and surgical palliation for single ventricle patients. His basic research has focused on ex vivo perfusion, and further studies performed when he worked as a research fellow at The Hospital for Sick Children are still being processed.